Search

Chronic diseases are a major health problem worldwide, especially in lower-income jurisdictions. Considering this scenario, the World Health Organization has recently established, as a research priority, preventive interventions for populations from lower-income countries, such as the middle-income country of Brazil. The purpose of this article is to describe the components of a pan-Canadian lifestyle program adapted to Brazilians and to report its health and fitness outcomes. A 12-week program called ACCELERATION was translated and culturally adapted to Brazilians. A quasi-randomized controlled trial was designed, consisting of weekly emails and educational videos addressing risk factors for chronic disease. Health and fitness measures included body composition, cardiovascular variables, aerobic fitness, and muscular strength. The Brazilian experimental group showed maintenance in heart rate, blood pressure, and VO2max values while presenting an improvement of 3.3% in body fat percentage (p = 0.040, d = −0.325) and 5.1% in muscular strength (p = 0.039, d = 0.328). Overall, these results were similar to the Canadian intervention. Based on these findings, the Brazilian version of the program has the potential to contribute to the fight against chronic diseases in Brazil.

This study examined the shift parameters that contribute to sleep loss and on-duty fatigue in British Columbia Wildfire Service (BCWS) firefighters using sleep–wake data, work–rest data and alertness and fatigue predictions from a biomathematical model (BMM) of fatigue. A total of 40 firefighters (age: 30.4 ± 11.6 years; 13 F, 26 M) volunteered over a 14-day consecutive fireline deployment, followed by a 3-day rest period, at two separate fires in British Columbia (during the 2015 fire season). Sleep–wake data were obtained using a wrist-worn accelerometer and self-reported sleep logs. Shift start and end times were provided by the BCWS at the completion of the study. Sleep and shift data were manually entered into a validated BMM (Circadian Alertness Simulator) to generate fatigue scores and shift work patterns. Shift duration was the major contributor to fatigue, as 46% (n = 274) of shifts were ≥14 h in length and the average shift length was 13.0 ± 0.62 h. However, none of the firefighters had a high-risk fatigue score (>60). The findings from this study indicated that using a BMM of fatigue can provide important insights into shift-work parameters that contribute to workplace fatigue and sleep loss in wildland firefighters.

Summary The health benefits of regular physical activity and/or exercise participation are clear. There is overwhelming evidence from large population-based and randomized controlled trials demonstrating the positive role that routine physical activity/exercise plays in the primary and secondary prevention of at least 25 chronic medical conditions and premature mortality. In this article, we discuss how diseases of the cardiovascular system appear to be particularly affected by physical activity and exercise levels. We also discuss the relatively poor uptake of various national and international guidelines that adopt threshold- and deficits-based messaging highlighting the need to meet specific physical activity targets and the perils of engaging in too little physical activity or exercise. We argue that threshold- and deficits-based messaging misses a great opportunity for health and wellness change. We also emphasize how this form of messaging may actually increase the barriers for those seeking to become healthier through routine physical activity. We highlight the importance of taking a strengths-based approach to health and wellness that builds upon the innate strengths of individuals, families, and communities. We argue that a strengths-based approach provides a greater opportunity for enhancing health and wellness that is more inclusive for everyone.

To understand the association between heart rate variability and indices of fatigue, total sleep time, and reaction time in shift workers. Ten participants from the British Columbia Wildfire Service management team were examined over a 14-day active fire-line period. Daily measures of subjective fatigue, sleepiness, and alertness were recorded using a visual analog scale. Daily total sleep time was recorded using a wrist actigraph. Cardiac autonomic modulation was examined each morning using heart rate variability (HRV). Three measures of reaction time (simple reaction time, choice reaction tie, and discriminatory reaction time) was examined on days 1, 5, 10, and 14. Multiple linear regression analysis was utilized to examine the association between HRV and indices of fatigue, total sleep time, and reaction time. Mean shift duration was 13.8 ± 0.77 h. Significant inverse associations were observed between HRV and sleepiness [r = − 0.60, p = 0.000] and fatigue [r = − 0.55, p = 0.000], and a positive association with total sleep time (min) [r = 0.28, p = 0.009]. There were no significant relationships between HRV and simple reaction time (ms) [r = − 0.32, p = 0.182], choice reaction time (ms) [r = − 0.10, p = 0.850], or discriminatory reaction time (ms) [r = − 0.09, p = 0.881]. HRV displayed significant associations with indices of fatigue and sleep, whereby demonstrating its utility as a practical tool for monitoring the development of fatigue in wildland firefighters and for providing insight when to make lifestyle modifications to preserve alertness.

Background Inter-limb asymmetry above a certain threshold in functional performance indicates increased injury risk in sports. Fatigue has been found to increase bilateral asymmetry in lower-limb jumping performance among high-school and adult athletes, whereas this impact has not been examined in child athletes. This study aimed to examine the effect of fatigue on inter-limb asymmetry in functional performances in elite Taekwondo athletes aged between 9 and 11 years. Methods Performance of single-leg jumps, Star Excursion Balance Test (SEBT), and muscle (hamstring and gastrocnemius) flexibility were measured for 13 elite male child Taekwondo athletes (aged 9.85 ± 0.80 years) at both the rested and fatigued states to examine the inter-limb asymmetry. A two-way repeated measures ANOVA was conducted to examine for difference and the interaction between limb (dominant, non-dominant leg) and state (rested, fatigued state) for each test. Paired t test or Wilcoxon signed-rank test was used to compare the asymmetry magnitude at the rested vs. fatigued state for each test, and the variation of performance post fatigue in the dominant vs. non-dominant leg when appropriate. Results The inter-limb asymmetry in triple-hop distance significantly (p = 0.046) increased with fatigue, whereas the asymmetry significantly (p = 0.004) decreased with fatigue in anterior (ANT) reach distance in SEBT. A significant (p = 0.027) limb by state interaction was shown for posterolateral (PL) reach distance in SEBT, wherein a significant (p = 0.005) bilateral difference was only shown at the rested state. The PL reach distance showed a significantly greater decrease (p = 0.028) post fatigue when using the dominant leg for support compared to using the non-dominant leg. Conclusions Fatigue significantly impacts inter-limb asymmetry in jump performances and dynamic balance for child athletes, while the variation of inter-limb asymmetry post fatigue may be different across tests. For the purpose of injury prevention, practitioners should consider assessing the inter-limb asymmetry for children at both the rested and fatigued state and be mindful of the fatigue response of each leg in functional tests.

The purpose of this investigation was to enhance our understanding of the effects the current British Columbia Wildfire Service (BCWS) firefighting schedule have on the development of fatigue and sleep deprivation. This was a cohort study that objectively and subjectively measured sleep quantity, sleep quality, and fatigue throughout a 17-day British Columbia wildland firefighting deployment. Wildland firefighters (n = 30) conducted daily testing of sleep and fatigue measures during 14 days of activity on the fire line and three days immediately post deployment during their three-day rest period, for a total of 17 days of data collection. Sleep was assessed using wrist-worn actigraphy (ActiGraph LLC, Pensacola, FL) and subjective sleep questionnaires. Fatigue was assessed using subjective fatigue questionnaires and cognitive performance through the psychomotor vigilance test. Total sleep time was less on fire days (

Objectives Exergames may be one viable way to increase child physical activity, but investigation of long term motivation, and prediction of adherence has seen little research attention. The purpose of this study was to compare the effect of an exergame intervention (exergame bike, standard bike) among children aged 10–14 years on motivational variables (self-determination theory, theory of planned behavior) and to explore whether these variables could predict use of the equipment across three months. Design Randomized controlled trial. Method: Seventy-three insufficiently active children were recruited through advertisements within the community/schools and randomized to either an exergame condition (n = 39) or a standard bike condition (n = 34). Weekly bike use was recorded in a log-book and motivational variables were assessed after a familiarization session and at six weeks. Results Exposure to exergames conferred higher affective and instrumental attitudes, perceived behavioral control, intention, and intrinsic motivation compared to the comparison condition, but this difference was not present by the six-week point of the trial. Children who had higher intention to use the bikes and extrinsic regulation were more likely to use the bikes from six weeks to three months, but no assessed psychological variable could account for use during the first six weeks. Conclusions Single-exposure research designs may not accurately reflect the motivations for longer term exergame play. Further, parent consumers of exercise equipment for the family home may benefit from considering how much their children would enjoy using the equipment after repeated exposures.

Background Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM. Methods This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses. Results Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25–75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00–124.14) vs (53.19 (35.68–63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74–16.22) vs 8.56 (6.18–10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (β = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (β = − 0.001, p = 0.018, model R2 = 0.205) and METs (β = − 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (β = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM. Conclusions Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

To understand the association between heart rate variability and indices of fatigue, total sleep time, and reaction time in shift workers.Ten participants from the British Columbia Wildfire Service management team were examined over a 14-day active fire-line period. Daily measures of subjective fatigue, sleepiness, and alertness were recorded using a visual analog scale. Daily total sleep time was recorded using a wrist actigraph. Cardiac autonomic modulation was examined each morning using heart rate variability (HRV). Three measures of reaction time (simple reaction time, choice reaction tie, and discriminatory reaction time) was examined on days 1, 5, 10, and 14. Multiple linear regression analysis was utilized to examine the association between HRV and indices of fatigue, total sleep time, and reaction time.Mean shift duration was 13.8 ± 0.77 h. Significant inverse associations were observed between HRV and sleepiness [r = - 0.60, p = 0.000] and fatigue [r = - 0.55, p = 0.000], and a positive association with total sleep time (min) [r = 0.28, p = 0.009]. There were no significant relationships between HRV and simple reaction time (ms) [r = - 0.32, p = 0.182], choice reaction time (ms) [r = - 0.10, p = 0.850], or discriminatory reaction time (ms) [r = - 0.09, p = 0.881].HRV displayed significant associations with indices of fatigue and sleep, whereby demonstrating its utility as a practical tool for monitoring the development of fatigue in wildland firefighters and for providing insight when to make lifestyle modifications to preserve alertness.

Bilateral asymmetry in lower-limb power and dynamic balance has been associated with increased risk of sport injury, whereas there is a lack of research examining this asymmetry for child athletes. Twenty-eight fencers (19 boys and 9 girls, aged 9.71 ± 1.08 years) and 28 Taekwondo athletes (19 boys and 9 girls, aged 9.71 ± 1.08 years) were examined on the single-leg jump and Star Excursion Balance Test (SEBT) performance. A mixed model design ANOVA (2 [Sex: Boys, Girls] × 2 [Sport group: Fencing, Taekwondo] × 2 [Limb: Dominant, Non-dominant Leg]) was conducted to examine for difference for each test. There was a significant main effect of limb on hop and triple hop distance (

Early childhood is an opportune time to develop physical literacy, acquire movement skills, and promote physical activity. Little is known about early childhood educators’ competence (ECEs) and con...

OBJECTIVE: Indigenous populations experience greater proportions of cardiovascular disease, diabetes, and obesity, though lower rates of hypertension. This investigation evaluated blood pressure relationships with vascular measures, anthropometry, cultural identity, and smoking status among Canadian Indigenous and European adults. METHODS: In 2013, in Vancouver, Canada, blood pressure, anthropometry, cultural identity, smoking status, pulse wave velocity (PWV), arterial compliance, baroreceptor sensitivity, and intima-media thickness (IMT) were directly measured among 58 Indigenous (39 ± 18 years, 31 female) and 58 age- and sex-matched European Canadian (42 ± 18 years) adults. Systolic (SBP) and diastolic (DBP) blood pressures were related to vascular measures, and hypertension was related to anthropometry, cultural identity, and smoking status. RESULTS: Similar vascular measures were recorded between Indigenous and European adults, respectively (PWV 5.3 ± 2.4 vs. 6.2 ± 3.4 m s(−1), p = 0.12; IMT 0.59 ± 0.11 vs. 0.61 ± 0.11 mm, p = 0.40; and large arterial compliance 16.1 ± 6.4 vs. 17.5 ± 6.6 mL mmHg(−1) × 10, p = 0.26). Similar relationships between vascular measures with SBP and DBP were identified between Indigenous and European adults (spectral baroreceptor sensitivity and SBP, r = 0.48, p = 0.001 vs. r = − 0.11, p = 0.44; ethnic difference p = 0.38; PWV; and DBP, r = 0.23, p = 0.09 vs. r = 0.06, p = 0.65, ethnic difference p = 0.23). Anthropometry only related to blood pressures among Europeans. Cultural identity only related to blood pressures among Indigenous populations. Smoking was not related to hypertension. CONCLUSION: Similar vascular measures between Indigenous and European Canadians were identified among populations experiencing similar social determinants of health.

Background: Risk factors for non-contact lower-limb injury in pediatric-age athletes and the effects of lateral dominance in sport (laterally vs. non-laterally dominant sports) on injury have not been investigated. Purpose: To identify risk factors for non-contact lower-limb injury in pediatric-age athletes. Methods: Parents and/or legal guardians of 2269 athletes aged between 6–17 years were recruited. Each participant completed an online questionnaire that contained 10 questions about the athlete’s training and non-contact lower-limb injury in the preceding 12 months. Results: The multivariate logistic regression model determined that lateral dominance in sport (adjusted OR (laterally vs. non-laterally dominant sports), 1.38, 95% CI, 1.10–1.75, p = 0.006), leg preference (adjusted OR (right vs. left-leg preference), 0.71, 95% CI, 0.53–0.95, p = 0.023), increased age (adjusted OR, 1.21, 95% CI, 1.16–1.26, p = 0.000), training intensity (adjusted OR, 1.77, 95% CI, 1.43–2.19, p = 0.000), and training frequency (adjusted OR, 1.36, 95% CI, 1.25–1.48, p = 0.000) were significantly associated with non-contact lower-limb injury in pediatric-age athletes. Length of training (p = 0.396) and sex (p = 0.310) were not associated with a non-contact lower-limb injury. Conclusions: Specializing in laterally dominant sports, left-leg preference, increase in age, training intensity, and training frequency indicated an increased risk of non-contact lower-limb injury in pediatric-age athletes. Future research should take into account exposure time and previous injury.

Exercise hypertension is a common occurrence among individuals with aortic coarctation. Although exercise is known to be beneficial among the general population, the risks and benefits of exercise among those with aortic coarctation are less clear. This systematic review evaluates the benefits and risks of exercise for persons with aortic coarctation. Electronic databases were systematically searched (that is, MEDLINE and EMBASE) and key reviews cross-referenced to identify articles for inclusion. Original research articles reporting exercise among individuals with aortic coarctation were included. From 2608 individual citations, 68 eligible articles were identified. Aerobic exercise stress tests were found to be useful for determining exercise hypertension experiences post-surgical repair (N=5), and other long-term secondary findings (N=3). Experiences of exercise hypertension were associated with abnormal cardiac and/or aortic geometry and cardiac function (N=7). Exercise capacity was generally found to be similar to non-aortic coarctation controls post surgery (N=6). Exercise hypertension was experienced by 27% of participants, including 10% of adults and 43% of children/youth. Individuals who experience exercise hypertension experience greater increases in systolic blood pressure with exercise. No investigations identified evaluated forms of exercise other than aerobic stress tests and no exercise training programs have been conducted to date. Exercise stress tests can be valuable in this population for determining exercise hypertension, especially in the year post-surgical repair. Additional research is urgently needed to accurately assess the benefits and risks of exercise and exercise hypertension, and applicability of exercise restrictions for this population.

Exergames may be one way to increase child physical activity, but long term adherence has seen little research attention. The primary objective of this study was to evaluate the usage of an exergame bike in comparison to a stationary bike in front of a TV across 3-months within a family home environment among children aged 10–14 years old. Seventy-three inactive children were recruited through advertisements and randomized to either the exergame condition (n = 39) or the standard bike condition (n = 34). Weekly bike use was recorded in a log-book. Both groups declined in bike use over time (t = 3.921, p

There is inconclusive evidence concerning the effects of routine participation in ultra-endurance events on cardiovascular disease (CVD) risk. Arterial compliance is a reliable, non-invasive, and effective tool for evaluating CVD risk. The purpose of this research was to examine if race length influences acute changes in arterial compliance following an ultra-marathon event. A total of 46 ultra-marathon runners were recruited including 21 participants (39.8 ± 8.3 years, 6 females) in the 80-km event and 25 participants (43.7 ± 9.8 years, 3 female) in the 195-km event. Arterial compliance was measured via radial applanation tonometry (CR-2000, HDI) for diastolic pulse contour analysis before and following the race. Significant between-group differences were found for changes in large arterial compliance with a decrease (increase in stiffness) following the 195-km event and an increase following the 80-kilometre event (p .05). Longer race lengths are associated with greater reductions in large arterial compliance following recreational ultra-marathon running. Assessment of arterial compliance might be a useful prognostic tool to assess the long-term risk of CVD among ultra-marathon runners.

Our special series on Cardiac Rehabilitation outlined the importance of routine physical activity and/or exercise participation in the primary and secondary prevention of cardiovascular disease and many other chronic medical conditions. The evidence is overwhelming, demonstrating that nearly everyone can benefit from becoming more physically active. This messaging has been widely disseminated at regional, national, and international levels. Often, this messaging highlights a physical inactivity crisis and the health perils of not engaging in sufficient amounts of physical activity. This deficits-based messaging often includes generic threshold-based recommendations stating that health benefits can only be accrued with specific volumes or intensities of physical activity. In this Editorial, we argue that the current generic and deficits-based messaging misses a great opportunity to focus on the positive and to facilitate hope and real change at the individual, community, and population levels. We advocate a strengths-based approach to health and wellness promotion that focuses on the innate strengths of individuals, families, and communities to enable self-empowerment and self-determination related to health and wellness. By taking a strengths-based approach, we can build hope, promoting the positive aspects of routine physical activity and exercise participation and providing a greater opportunity to enhance health and wellbeing for everyone.

Effective behavior change approaches are necessary to help individuals avoid or mitigate risk factors, engage in behavioral patterns that lead to better health, and consequently, prevent several chronic diseases. Physical inactivity is considered one of the most harmful risk factors for chronic medical conditions, and although different strategies are used to tackle this behavior, not all of them lead to the expected or desired results. This brief commentary examines recent approaches aimed at physical activity behavior change. We find that a combination of strategies focusing on streamlining the access to physical activity seems to be more effective than individual approaches, in order to increase physical activity engagement to prevent chronic diseases in adults.

Community-based and Indigenous-led health and wellness approaches have been widely advocated for Indigenous peoples. However, remarkably few Indigenous designed and led interventions exist within the field. The purpose of this study was to evaluate an Indigenous-led and community-based health and wellness intervention in a remote and rural Indigenous community. This protocol was designed by and for Indigenous peoples based on the aspirations of the community (established through sharing circles). A total of 15 participants completed a 13-week walking and healthy lifestyle counselling program (incorporating motivational interviewing) to enhance cardiometabolic health. Measures of moderate-to-vigorous physical activity (MVPA, 7-day accelerometry and self-report), predicted maximal aerobic power (VO2max, 6-min walk test), resting heart rate and blood pressure, and other health-related physical fitness measures (musculoskeletal fitness and body composition) were taken before and after the intervention. The intervention led to significant (p &lt, 0.05) improvements in VO2max (7.1 &plusmn, 6.3 % change), with the greatest improvements observed among individuals with lower baseline VO2max (p &lt, 0.05, r = -0.76). Resting heart rate, resting systolic blood pressure, and resting diastolic blood pressure decreased significantly (p &lt, 0.05) after the intervention. Self-reported and accelerometry-measured frequency of MVPA increased significantly (p &lt, 0.05), and the total MVPA minutes (~275 min/week) were above international recommendations. Change in VO2max was significantly correlated with change in self-reported (r = 0.42) and accelerometry-measured (r = 0.24) MVPA minutes. No significant changes were observed in weight, body mass index, waist circumference, body fat (via bioelectrical impedance), grip strength, and flexibility. These findings demonstrate that a culturally relevant and safe, community-based, Indigenous-led, health and wellness intervention can lead to significant and clinically relevant improvements in cardiometabolic health and physical activity behaviour, with the greatest changes being observed in the least active/fit individuals.

Exercise is advocated in the management of type 1 diabetes (T1D), but the effects of different forms of exercise training on cardiovascular risk factors in T1D still remain unclear. The aim of this study was to conduct a systematic review and meta-analysis on exercise training for cardiovascular risk factors in T1D. Six electronic databases were systematically searched for randomized or non-randomized controlled studies reporting associations between exercise training and cardiovascular risk factors in T1D. Weighted mean differences (WMD) of each cardiovascular risk factor between exercise groups and control groups were calculated using a random effects model. A total of 24 studies reported the effects of exercise training on cardiovascular risk factors. Exercise training increased maximal aerobic power (3.01 mL·kg−1·min−1, 95% confidence interval, CI, 0.94 to 6.38) and reduced glycated hemoglobin (HbA1c; −0.45%, 95% CI −0.73 to −0.17), daily insulin dosage (−0.88 U·kg−1, 95% CI −1.27 to −0.48), and total cholesterol (−0.38 mmol·L−1, 95% CI −0.71 to −0.04). Exercise training did not lead to consistent changes in body mass index (BMI), blood pressure, triglycerides, high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C). In persons living with T1D, exercise training is associated with a beneficial cardiovascular profile, including improvements in lipid profile, glycemic control (decreased daily insulin dosage and HbA1c), and aerobic fitness.

Heart transplantation patients generally demonstrate exercise capacities that are below the minimal standards for firefighting. Therefore, it is unlikely that heart transplantation patients will receive medical and/or employer clearance for active duty. We report a case of a firefighter who sought to return to full-time active duty following heart transplantation. We examined his physiological readiness to return to work during occupation-specific testing. Remarkably, the patient was able to meet the minimal requirements for full active firefighting. This finding provides direct evidence to support the potential of transplant patients returning to active duty in physiologically demanding occupations.

The health benefits of regular physical activity are irrefutable; virtually everyone can benefit from being active. The evidence is overwhelming with risk reductions of at least 20%-30% for more than 25 chronic medical conditions and premature mortality. Even higher risk reductions (ie, ≥ 50%) are observed when objective measures of physical fitness are taken. International physical activity guidelines generally recommend 150 minutes per week of moderate- to vigorous-intensity physical activity. A critical review of the literature indicates that half of this volume of physical activity might lead to marked health benefits. There is compelling evidence to support health promotion strategies that emphasize that health benefits can be accrued at a lower volume and/or intensity of physical activity. Public health policies are needed that reduce the barriers to physical activity participation such that everyone can reap the benefits of physical activity. It is also important to highlight that sedentary time (particularly sitting time) carries independent health risks. The simple message of "move more and sit less" likely is more understandable by contemporary society and is formed on the basis of a strong body of evidence. For practitioners who work directly with clients, it is recommended that an individualized prescription (dosage) that takes into consideration the unique characteristics and needs of the client is provided. Physical activity or exercise promotion should not be done in isolation; it should be part of an integrated approach to enhance healthy lifestyle behaviours.

Regular physical activity is an effective primary and secondary preventative strategy for more than 25 chronic medical conditions with common risk reductions of 20%–30%. International physical activity messaging generally advocates 150 min/week of moderate-to-vigorous-intensity physical activity (MVPA) as the minimal level of physical activity for health benefits. However, a critical analysis of the literature indicates that physical activity levels less than 50% of current international guidelines can lead to marked and clinically relevant health benefits (particularly for those unaccustomed to routine physical activity and/or living with a chronic medical condition). Growing evidence suggests that lower physical activity targets may be more palatable for those that serve to benefit greatly from physical activity. It is advisable that health agencies revisit their physical activity messaging to avoid a fundamental knowledge translation error that can create an unnecessary barrier for individuals that can experience marked health benefits from becoming more physically active.

Limited understanding of Indigenous adults’ cardiovascular structure and function exists despite high rates of cardiovascular disease. This investigation characterised cardiovascular structure and function among young Indigenous adults and compared to age- and sex-matched European descendants. Echocardiographic assessments included apical two- and four-chamber images, parasternal short-axis images and Doppler. Analyses included cardiac volumes, dimensions, velocities and strains. Cardiovascular structure and function were similar between Indigenous (n=10, 25 ± 3 years, 4 women) and European-descendant (n=10, 24 ± 4 years, 4 women,) adults, though European descendants demonstrated greater systemic vascular resistance (18.19 ± 3.94 mmHg∙min−1∙L−1 vs. 15.36 ± 2.97 mmHg∙min−1∙L−1, p=0.03). Among Indigenous adults, women demonstrated greater arterial elastance (0.80 ± 0.15 mmHg·mL−1·m−2 vs. 0.55 ± 0.17 mmHg·mL−1·m−2, p=0.02) and possibly greater systemic vascular resistance (17.51 ± 2.20 mmHg∙min−1∙L−1 vs. 13.93 ± 2.61 mmHg∙min−1∙L−1, p=0.07). Indigenous men had greater cardiac size, dimensions and output, though body size differences accounted for cardiac size differences. Similar cardiac rotation and strains were observed across sexes. Arterial elastance and cardiac size were different between Indigenous men and women while cardiovascular structure and function may be similar between Indigenous and European descendants.

OBJECTIVE To evaluate sex differences in left ventricular (LV) function after an ultramarathon, and the association of vascular and training indices with the magnitude of exercise-induced cardiac fatigue. DESIGN Descriptive field study. SETTING Fat Dog 100 Ultramarathon Trail Race, Canada. PARTICIPANTS Thirty-four (13 women) recreational runners (aged 28-56 years). INTERVENTIONS A 100-km or 160-km mountain marathon. MAIN OUTCOME MEASURES Baseline baroreceptor sensitivity, heart rate variability, and arterial compliance; Pre-exercise and postexercise echocardiographic evaluations of LV dimensions, volumes, Doppler flow velocities, tissue velocities, strain, and strain rate. RESULTS Finishers represented 17 men (44.8 ± 6.6 years) and 8 women (45.9 ± 10.2 years; P = 0.758). After ultraendurance exercise, significant reductions (P < 0.05) in fractional shortening (men: 40.9 ± 6.9 to 34.1 ± 7.6%; women: 42.5 ± 6.5 to 34.6 ± 7.9%) diastolic filling (E/A, men: 1.28 ± 0.68 to 1.26 ± 0.33; women: 1.55 ± 0.51 to 1.30 ± 0.27), septal and lateral tissue velocities (E'), and longitudinal strain (men: -21.02 ± 1.98 to -18.44 ± 0.34; women: -20.28 ± 1.90 to -18.44 ± 2.34) were observed. Sex differences were found for baseline cardiac structure and global function, peak late transmitral flow velocity, and estimates of LV filling pressures (P < 0.05). Regression analysis found that higher baseline arterial compliance was associated with lower reductions in cardiac function postexercise, to which sex was a significant factor for E' of the lateral wall. Faster race pace and greater lifetime ultramarathons were associated with lower reductions in LV longitudinal strain (P < 0.05). CONCLUSIONS Cardiac responses after an ultramarathon were similar between men and women. Greater evidence of exercise-induced cardiac fatigue was found to be associated with lower baseline arterial compliance and training status/experience. CLINICAL RELEVANCE These findings suggest that vascular health is an important contributor to the degree of cardiovascular strain incurred as the result of an acute bout of prolonged strenuous exercise.

AB Indigenous populations currently experience greater rates of cardiovascular disease. Although ethnic differences in cardiovascular responses to exercise have previously been identified, these responses among indigenous populations are unknown. Purpose: This investigation aimed to evaluate the vascular responses to aerobic exercise of Canadian indigenous and European adults. Methods: Twelve age- and sex-matched indigenous and European adults completed a cycle ergometer maximal aerobic power test and submaximal 30 min of 60% maximal aerobic capacity on two separate days. Blood pressure, pulse wave velocity, baroreceptor sensitivity, arterial compliance, vascular resistance, and intima-media thickness were directly measured before and after aerobic exercises. Results: Vascular responses to exercise were generally similar between indigenous and European adults including decreases in baroreceptor sensitivity and vascular resistance after maximal exercise. No changes in intima-media thickness, pulse wave velocity, and arterial compliance were observed after exercise in either group. However, after submaximal exercise, only European adults demonstrated reductions in baroreceptor sensitivity (spectral: 9.2 +/- 4.3 to 11.5 +/- 6.7 ms[middle dot]mm Hg-1, P = 0.41, vs 15.8 +/- 8.3 m[middle dot]s-1 to 8.9 +/- 5.7 ms[middle dot]mm Hg-1, P = 0.02; sequence: 14.6 +/- 5.4 to 16.5 +/- 11.0 ms[middle dot]mm Hg-1, P = 0.48, vs 26.2 +/- 10.5 m[middle dot]s-1 to 15.4 +/- 9.4 ms[middle dot]mm Hg-1, P = 0.02). Similarly, decreases in blood pressure after exercise were observed only among European adults. Conclusions: Indigenous adults demonstrated vascular responses similar to those demonstrated by European adults, although blood pressure was only observed to decrease among European adults after maximal and submaximal exercise, and baroreceptor sensitivity, after submaximal exercise.

The health benefits of physical activity and exercise are clear; virtually everyone can benefit from becoming more physically active. Most international guidelines recommend a goal of 150 min/week of moderate-to-vigorous intensity physical activity. Many agencies have translated these recommendations to indicate that this volume of activity is the minimum required for health benefits. However, recent evidence has challenged this threshold-centered messaging as it may not be evidence-based and may create an unnecessary barrier to those who might benefit greatly from simply becoming more active. This systematic review evaluates recent systematic reviews that have examined the relationship between physical activity and health status.Systematic reviews and/or meta-analyses (based largely on epidemiological studies consisting of large cohorts) have demonstrated a dose-response relationship between physical activity and premature mortality and the primary and secondary prevention of several chronic medical conditions. The relationships between physical activity and health outcomes are generally curvilinear such that marked health benefits are observed with relatively minor volumes of physical activity.These findings challenge current threshold-based messaging related to physical activity and health. They emphasize that clinically relevant health benefits can be accrued by simply becoming more physically active. VIDEO ABSTRACT: http://links.lww.com/HCO/A42.

Objectives The purpose of this study was to examine the use of home exercise equipment in the form of exergame cycling compared to a stationary recumbent bicycle ergometer in front of TV in the home over 3 months among parents of an intervention with their inactive children. The primary outcome was bike use (total weekly duration). Predictors of bike use in the form of theory of planned behavior and self-determination theory were also examined. Design Randomized controlled trial. Method Sixty eight parents of children aged 10–14 were randomized to either the exergame condition (n = 36) or the standard bike condition (n = 32). Weekly bike use was recorded in a log-book. Results The exergame bike and a standard bike in front of a TV had similar use across three months (p = .13, ηp2 = .02), which declined over time (p Conclusions The findings suggested that irrespective of modality, use of exercise equipment declined considerably for parents over three-months. Parents may also benefit from family physical activity interventions, but it depends on their physical activity status, how much they would enjoy using the equipment, and their overall perceived control over being physically active. Trial registration clinicaltrials.gov #NCT01373762. Registered 1 June 2011.

To provide a broad overview of the state of physical activity (PA) research in the form of (1) definitions of PA, (2) health benefits, (3) prevalence, (4) correlates and (5) interventions.A high-level overview of published reviews of the literature.Regular PA is an effective primary and secondary preventative strategy against at least 25 chronic medical conditions with risk reduction typically in the 20-30% range. While approximately 75% of adults meet recommended PA guidelines, the prevalence is slightly lower for women compared to men, and considerably lower for youth, older adults and those in higher income countries. Motivation, self-efficacy and self-regulation remain consistent correlates of PA. Interventions show PA changes in the small effect size range for adults and youth but the heterogeneity is considerable across studies. Only a few (aggregate of behavioural regulation strategies, supervision, high frequency of contact) reliable moderators of intervention success were identified across study quality, sample characteristics, theory/behaviour change techniques and delivery modes/settings.PA research should continue to examine the mechanisms causing health outcomes, the dose that can lead to clinically relevant changes in health status, the scope and validity of PA surveillance and innovative behaviour change techniques, while improving the reach and duration of PA interventions.

An acute reduction in blood pressure observed after a single bout of exercise is termed post-exercise hypotension (PEH). In contrast to moderate intensity aerobic exercise, little is known about the PEH response following high-intensity interval exercise. The present purpose is to assess how sex and training status impact PEH following high-intensity interval exercise. Cardiac volumes and function via echocardiography were measured in 40 normotensive, endurance-trained (ET) and normally active (NA) men and women (Age ± SD = 30.5 ± 5.7) following high-intensity interval cycle exercise. Continuous measurements of ECG and beat-by-beat blood pressure were collected before and 30 min post-exercise for determination of cardiovagal baroreflex function (BRS and αLF), spectral analysis of heart rate and systolic blood pressure (SBP LF). Post-exercise systolic BP was significantly reduced from baseline, occurring to a greater degree in ET compared with NA (−12.9 vs. −5.3 mmHg, P = 0.008), while mean arterial pressure was similarly reduced in all groups (−4.6 mmHg, P = 0.003). Despite reduced SVI and TPRI, CI was increased post-exercise (P

The health benefits of exercise are well established. However, the relationship between exercise volume and intensity and health benefits remains unclear, particularly the benefits of low-volume and intensity exercise.The primary purpose of this investigation was, therefore, to examine the dose-response relationship between exercise volume and intensity with derived health benefits including volumes and intensity of activity well below international recommendations.Generally healthy, active participants (n = 72; age = 44 ± 13 years) were assigned randomly to control (n = 10) or one of five 13-week exercise programs: (1) 10-min brisk walking 1×/week (n = 10), (2) 10-min brisk walking 3×/week (n = 10), (3) 30-min brisk walking 3×/week (n = 18), (4) 60-min brisk walking 3×/week (n = 10), and (5) 30-min running 3×/week (n = 14), in addition to their regular physical activity. Health measures evaluated pre- and post-training including blood pressure, body composition, fasting lipids and glucose, and maximal aerobic power (VO2max).Health improvements were observed among programs at least 30 min in duration, including body composition and VO2max: 30-min walking 28.8-34.5 mL kg(-1) min(-1), 60-min walking 25.1-28.9 mL kg(-1) min(-1), and 30-min running 32.4-36.4 mL kg(-1) min(-1). The greater intensity running program also demonstrated improvements in triglycerides.In healthy active individuals, a physical activity program of at least 30 min in duration for three sessions/per week is associated with consistent improvements in health status.

Persons living with chronic medical conditions (such as coronary artery disease (CAD)) are thought to be at increased risk when exposed to air pollution. This systematic review critically evaluated the short-term health effects of air pollution in persons living with CAD. Original research articles were retrieved systematically through searching electronic databases (e.g., Medical Literature Analysis and Retrieval System Online (MEDLINE)), cross-referencing, and the authors’ knowledge. From 2884 individual citations, 26 eligible articles were identified. The majority of the investigations (18 of 22 (82%)) revealed a negative relationship between air pollutants and cardiac function or overall health. Heart rate variability (HRV) was the primary cardiovascular outcome measure, with 10 out of 13 studies reporting at least one index of HRV being significantly affected by air pollutants. However, there was some inconsistency in the relationship between HRV and air pollutants, mediated (at least in part) by the confounding effects of beta-blocker medications. In conclusion, there is strong evidence that air pollution can have adverse effects on cardiovascular function in persons living with CAD. All persons living with CAD should be educated on how to monitor air quality, should recognize the potential risks of excessive exposure to air pollution, and be aware of strategies to mitigate these risks. Persons living with CAD should minimize their exposure to air pollution by limiting outdoor physical activity participation when the forecast air quality health index indicates increased air pollution (i.e., an increased risk).

High-intensity exercise induces marked physiological stress affecting the secretion of catecholamines. Sustained elevations in catecholamines are thought to desensitize cardiac beta receptors and may be a possible mechanism in impaired cardiac function following strenuous exercise. In addition, attenuated arterial-ventricular coupling may identify vascular mechanisms in connection with postexercise attenuations in ventricular function. Thirty-nine normally active (NA) and endurance-trained (ET) men and women completed an echocardiographic evaluation of left ventricular function before and after an acute bout of high-intensity interval exercise (15 bouts of 1:2 min work:recovery cycling: 100% peak power output and 50 W, respectively). Following exercise, time to peak twist and peak untwisting velocity were delayed ( P < 0.01) but did not differ by sex or training status. Interactions for sex and condition (rest vs. exercise) were found for longitudinal diastolic strain rate (men, 1.46 ± 0.19 to 1.28 ± 0.23 s−1 vs. women, 1.62 ± 0.25 to 1.63 ± 0.26 s−1; P = 0.01) and arterial elastance (men 2.20 ± 0.65 to 3.24 ± 1.02 mmHg·ml−1·m−2 vs. women 2.51 ± 0.61 to 2.93 ± 0.68 mmHg·ml−1·m−2; P = 0.04). No cardiac variables were found associated with catecholamine levels. The change in twist mechanics was associated with baseline aortic pulse-wave velocity ( r2 = 0.27, P = 0.001). We conclude that males display greater reductions in contractility in response to high-intensity interval exercise, independent of catecholamine concentrations. Furthermore, a novel association of arterial stiffness and twist mechanics following high-intensity acute exercise illustrates the influence of vascular integrity on cardiac mechanics.

Physical activity plays an important role in the primary and secondary prevention of cardiometabolic disease. Despite the health benefits of physical activity, levels of physical inactivity remain high throughout contemporary society. In recent years, there have been rapid advancements in the use of telehealth approaches for the promotion of physical activity and other healthy lifestyle behaviors. Telehealth counseling platforms have the potential to reach a wide population, lower costs, as well as increase accessibility to services irrespective of geographical region and socio-economic background. Given this context, the purpose of this article is to provide an overview of a novel approach to physical activity counseling via a free telephone-delivered and on-line resource called the Physical Activity Line. The Physical Activity Line has implemented the most advanced risk stratification and clearance strategy available (ie, PAR-Q+, ePARmed-X+) for the provision of evidence-based physical activity clearance and tailored exercise prescriptions for both healthy individuals, as well as for persons with established medical conditions (eg, cardiometabolic disease). The qualified exercise professional is also central to the PAL, playing an essential role in the safe and effective delivery of evidence-based physical activity counseling.

Summary Physical activity is beneficial for many chronic conditions. However, activity levels of Native Americans are not well known. This systematic review investigated if Native American populations achieve the recommended physical activity levels, compared current and past activity levels, and assessed the ability of exercise training programmes to improve health outcomes among this population. Electronic databases (e.g. MEDLINE, EMBASE) were searched and citations were cross-referenced. Included articles reported physical activity levels or investigations among Native Americans. This search identified 89 articles: self-report (n = 61), accelerometry and pedometry (n = 10), metabolic monitoring (n = 10) and physical activity interventions (n = 17). Few adults were found to meet the physical activity recommendations (27.2% [95% confidence interval = 26.9–27.5%] self-report, 9% [4–14%] accelerometry). Among children/youth, 26.5% (24.6–28.4%) (self-report) to 45.7% (42.3–49.1%) (pedometry/accelerometry) met the recommendations. Adults and children/youth were generally identified as physically inactive (via doubly labelled water). Overall, Native American adults reported lower activity levels since 2000, compared to 1990s, although similar to 1980s. Few physical activity interventions employed strong methodologies, large sample sizes and objective outcome measures. There is a clear need to increase Native American populations' physical activity. Additional research is required to evaluate exercise training programmes among this population.

Assessing health-related physical fitness is important for determining health status. However, verbal instructions provided during an assessment generally do not specify direction of attentional focus. This investigation examined the effect of attentional focus on performance outcomes during appraisals of health-related physical fitness. Eight females (25.0 ± 4.0 years) and 8 males (26.3 ± 3.9 years) completed 7 physical fitness tests of the Canadian Physical Activity, Fitness and Lifestyle Approach (modified Canadian Aerobic Fitness Test, grip strength, push-ups, sit and reach, partial curl-ups, vertical jump, and back extension) on 3 different days, each separated by 1 week. On day 1, no attentional focus was specified. On days 2 and 3, participants were asked to adopt an external focus (instructions focused attention away from the body) or an internal focus (instructions focused attention on the body's movement) in randomized order. Irrespective of sex, adopting an external focus resulted in significantly better performance on all tests when compared with no focus or internal-focus conditions. An internal focus also resulted in performance decrements for grip strength, push-ups, and vertical jump vs. no focus. These results demonstrate that instructing individuals to adopt an external focus provides a performance advantage on appraisals of aerobic and musculoskeletal fitness, whereas an internal focus may hinder performance. In some participants, these scores may convert to a rating of health status that is 1 health benefit zone higher or lower, respectively. This highlights further the importance of formulating verbal instructions that incorporate attentional focus for optimal performance on appraisals of physical fitness.

An investigation on large and small artery compliance in 36 able-bodied persons and persons with spinal cord injury (SCI).To evaluate the effect of various training states (endurance-trained vs untrained) on arterial compliance in individuals with chronic SCI of traumatic origin and in able-bodied individuals (matched for age, sex, height, and weight).Tertiary rehabilitation center in Canada.Large and small artery compliance were measured at the radial artery and physical activity was assessed via questionnaire.There was no significant difference in large artery compliance between groups. Small artery compliance was reduced markedly (5.8±3.1 ml mm Hg(-1) × 100) in untrained persons with SCI, in comparison to all other groups. Small artery compliance of endurance-trained individuals with SCI was slightly (4%) higher than that observed in the untrained able-bodied individuals (8.6±1.5 vs. 8.2±1.4 ml mm Hg(-1) × 100, respectively). Endurance-trained, able-bodied persons had greater small artery compliance (10.6±2.3 ml mm Hg(-1) × 100) in comparison to the all other groups.Endurance training is related to increased small artery compliance in able-bodied individuals and persons with SCI (who are matched for age, sex, height and weight). Endurance training may attenuate the decline in small artery compliance seen with SCI.

Patterns of physical activity (PA) and sedentary time, including volume of bouted activity, are important health indicators. However, the effect of accelerometer epoch length on measurement of these patterns and associations with health outcomes in children remain unknown.We measured activity patterns in 308 children (52% girls, age range = 8-11 years) using ActiGraph GT1M accelerometers with 15-s epochs and reintegrated to 60-s epochs. We calculated the volume (minutes per day) of moderate-to-vigorous PA (MVPA), sedentary time, light, moderate, and vigorous PA, as well as bouted MVPA and sedentary time (0-5 min, 5-10 min, 10-20 min, and20 min).The difference between 15-s and 60-s epochs was statistically significant for all outcomes; however, effect sizes were small or negligible in 30% of comparisons. Bias ranged from 1.9 min/day (total MVPA) to 102.7 min/day (0-5 min sedentary bouts). Regression-based estimates of bias and 95% limits of agreement illustrated that the magnitude, and in some cases, the direction, of between-epoch differences varied with activity level. Correlations with body mass index and cardiovascular fitness were similar for 15-s (r = -.19 to .20) and 60-s (r = -.16 to .29) epochs. Estimated 15-s data (predicted from 60-s) were similar to measured data and had similar relationships with health outcomes.Epoch length influences measurement of PA and sedentary patterns and the effect is modified by activity level. However, associations with health outcomes were similar and epoch differences can be adjusted. Future research should clarify the accuracy of different epoch lengths for measuring bouted activity and evaluate whether epoch length alters relationships with additional health outcomes.

The objective of this study is to compare arterial stiffness between those with spinal cord injury (SCI) and able-bodied (AB) individuals when matched for habitual level of physical activity.A total of 17 SCI and 17 AB individuals were matched for sex, age, weight, blood pressure, and levels of self-reported habitual physical activity (Godin-Shephard). Measures included central pulse wave velocity (PWV) (carotid-femoral PWV (cfPWV)) and lower limb PWV (femoral--toe PWV(ftPWV)) as well as large and small arterial compliance.The cfPWV was significantly elevated (7.3 ± 2.1 vs. 5.7 ± 1.4 m·s, P0.05) in SCI compared with AB. No other measures of arterial stiffness were different between the groups. Moderate to vigorous physical activity was significantly correlated with both large (r = 0.48, P0.05) and small (r = 0.65, P0.01) artery compliance, but not cfPWV or ftPWV.Both large and small artery compliance appear to be associated with habitual physical activity in physically active individuals with SCI. However, we did not show that physical activity is associated with PWV in physically active individuals with SCI. These findings suggest that factors other than physical inactivity may mediate the increase in arterial stiffness widely reported in the SCI population.